Vertigo

About Vertigo

Definition

Vertigo is a feeling of spinning when a person is standing still. It can be caused by many different health issues.

Causes

The inner ear and nerves sense the position of a person's head and body. Vertigo can happen when there are problems with these nerves and structures. It may also be due to problems in the brain, but this is not as common.

The two main types of vertigo are:

Peripheral Vertigo

Peripheral vertigo is common and caused by problems with the inner ear. Causes may be:

• Benign paroxysmal positional vertigo (BPPV)
• Meniere disease
• Perilymphatic fistula—an abnormal canal or connection in the inner ear
• Medicines that disrupt the inner ear's ability to balance
• Infection
• Acoustic neuroma—a benign tumor of the nerve that helps with hearing and balance
• Poor blood flow
• Injury
• Otosclerosis—a bony growth near the middle ear
• A displaced canalith—these are small crystals in the inner ear that help sense movement. They can sometimes move out of place and cause problems.

Central Vertigo

Central vertigo is less common but more serious. It happens due to changes in the brainstem or the cerebellum. These parts of the brain control balance. Changes can be caused by:

• Damage to the brain from diseases such as multiple sclerosis, stroke, or from tumors
• Migraine headaches
• Nervous system problems, such as Parkinson disease or multiple sclerosis
• Epilepsy
• Too much exposure to alcohol, heavy industrial metals, or poisons
• Injury

Risk Factors

The conditions above can raise a person's risk of vertigo.

Symptoms

A person with vertigo may have:

• Sensation of rotation
• Illusion of movement
• Feeling of being pulled in one direction
• Feeling of being off-balance

Vertigo is not the same as feeling lightheaded. A person who is lightheaded does not have a feeling of movement.

Diagnosis

The doctor will ask about symptoms and health history. A physical exam will be done. To look for a cause the doctor may also do:

• Blood tests
• Hearing and vision tests
• Head maneuvers—the doctor will move a person's head to help find out the cause of vertigo
• Blood pressure test, both lying down and standing up
• Electronystagmogram—to check for nystagmus, an abnormal eye movement
• MRI scan
• Rotatory chair test
• Brainstem auditory evoked potential studies—to see how the auditory nerve and brainstem are working

Treatment

Some lifestyle changes can help manage vertigo, such as using a cane to help with balance. Treating the cause may also stop the vertigo.

Some medicines that cause vertigo may need to be stopped or changed.

Medicines that may ease or stop symptoms are:

• Antihistamines
• Benzodiazepines
• Anticholinergics
• Antiemetics

Prevention

There are no current guidelines to prevent vertigo.

References

• Dizziness and vertigo. The Merck Manual Professional Edition. Available at: https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/approach-to-the-patient-with-ear-problems/dizziness-and-vertigo?query=vertigo.
• Dizziness in adults - approach to the patient. EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/dizziness-in-adults-approach-to-the-patient.
• Living with a vestibular disorder. Vestibular Disorders Association website. Available at: https://vestibular.org/living-vestibular-disorder/everyday-challenges.
• Muncie, H.L., Sirmans, S.M., et al. Dizziness: approach to evaluation and management. American Family Physician, 2017; 95 (3): 154-162.